Questions related to Breast Surgery
More women in the U.S. are choosing to have their breasts removed for early cancers instead of breast-conserving procedures that deliver equal results, according to a new study.
I am working on my MSc dissertation, investigating breast protection bras for female boxers. I am looking at their protection but also the fit and shaping of them and how this relates to their comfort during wear. Is there any sort of classification of the shape of women's breasts? How would I describe the natural breast shape?
What's the verdict on regional analgesia in breast surgery?
Is there any need to use it at all?
The 2018 Cochrane review concluded that synthesis of 18 RCTs favoured regional anaesthesia for the prevention of persistent pain three to 12 months after breast cancer surgery with an OR of 0.43 (95% CI 0.28 to 0.68, 1297 participants, low‐quality evidence).
However, the recent 11-year RCT published in the Lancet 2019 with 2132 patients across 13 hospitals internationally showed there was no difference in incisional pain:
Incisional pain was reported by 442 (52%) of 856 patients assigned to regional anaesthesia-analgesia and 456 (52%) of 872 patients allocated to general anaesthesia at 6 months, and by 239 (28%) of 854 patients and 232 (27%) of 852 patients, respectively, at 12 months (overall interim-adjusted odds ratio 1·00, 95% CI 0·85-1·17; p=0·99). Neuropathic breast pain did not differ by anaesthetic technique and was reported by 87 (10%) of 859 patients assigned to regional anaesthesia-analgesia and 89 (10%) of 870 patients allocated to general anaesthesia at 6 months, and by 57 (7%) of 857 patients and 57 (7%) of 854 patients, respectively, at 12 months.
If it doesn't reduce chronic post surgical pain, is there any point in using it?
(Note: these studies involved paravertebral regional analgesia)
So it is somewhat understood that a sentinel node biopsy after lumpectomy or a previous sentinel is contraindicated considering that the lymphatic supply is compromised already and it can lead to false negative results. A myth or not?
I have 38 old fm patient. Family history (+). 3 years ago we perfomed bilateral risk reduction mastectomy after a diagnosis of LCIS. Mastectomy was done with nipple sparing technique and retromuscular Becker prothesis. the follw up was uneventful until 1 month ago. Patient had a skin rash at his left breast inner quadrant. The biopsy of this area confirmed a invasive ductal tumor. The area contains 1/3 of his breast and have extension to the other breast .
do you prefer Surgery or a neoadjuvant chemo ?
should we the prothesis take don
Does any one knows any actual randomised trial to check on breast cancer recurrence after pectoralis fascia preservation?
A 41 yrs old woman with a 2*2 cm in UOQ left breast cancer and reactive node in axial at USO. Her mother had breast cancer at 50 yrs and BRCA mutation.Mamography showed only mass.What is your plan Mastectomy or BCT?
Serratus block is effective for mastectomy and also for axillary dissection? And I don't understand clearly the difference between Serratus and PEC's 2 (the injection of anesthetic is upper or underneath of serratus muscle?).
There are some patients with bulky and multifocal or multicentric breast cancer that with oncoplastia techniques could benefit of conservative surgery, I would like to know about this topic experiences.
I am interested to learn more regarding Kinesio taping efficacy on lymphoedma especially in cancer patients.
A patient underwent Hadfield procedure and was found to have high grade DCIS with several tiny foci of invasive ductal carcinoma. Now i need to do sentinel lymph node biopsy. Normally i do peri-aerolar injection of the dye. However, it is not possible in this case. Where should the dye be injected?
I mean: in order to have clear margins at extemporaneous pathological examination. You stick to preoperative design of removal? Use intra-operative ultrasound? Aim larger margins?...
I'm interested in nonrandomized, controlled trials, if any are available. I've been searching for such a study(ies) and have had no luck. I found anecdotal evidence and several nursing articles explaining post-op protocols (with no sources to back the protocols up).
Lipofilling or lipotransfer is a relatively new method to do secondary correction of smaller partial mastectomy defects after breast-conserving therapy of breast cancer. Do patients have an increased risk for local recurrences after lipofilling or is it a safe procedure in breast cancer patients ?
For the post masterctomy/lumpectomy radiation therapy, can someone enlighten me with the step-by-step procedure for reconstruction/radiation? I am not sure I fully understand the concept of "immediate reconstruction" - dose this mean implant without radiation? In addition, what dose "implant only" mean in this type of procedure? The radiation comes first, or the reconstruction comes first and then radiation?
I had a mastectomy for a 4 cm invasive Ductal CA on a 40 years old lady with sentinel node biopsy.Unfortunately frozen section instrument got a problem and we closed the wound without formal axillary dissection.Now I knew that 3 of 4 sentinel node was positive.Is it essential to do a formal axillary dissection in this patient?
presently skin excision is the answer for simon 's grade 3 gynecomastia for good cosmetic results
can anyone suggest if any other treatment guidelines available
As compared with autologous fat transfer breast auto-augmentation. Could these two techniques be combined ?
Measuring 'quality' in surgery has become important, as its only with measuring 'quality' that we can begin to make improvements in care. Various measures have been suggested, such as
Length of stay
Intra-operative injury rate (for example CBD injury / ureteric injury)
Rate of laparoscopic surgery
Rates of conversion to open surgery
to be measured to compare quality in surgery specifically.
Lots of these factors can vary naturally, with a hospitals patient population (rich, poor, age group, comorbidities, hospital size, urban, rural, delays in presentation, access to healthcare etc) and other factors such as surgeon training / experience etc and many other reasons. So variability in these factors is to be expected.
What makes a good 'quality marker' in surgery?
Your thoughts would be appreciated.
All the best
Any RCTs? In assessing the success of per-cutaneous needle aspiration for breast abscesses, part of exclusion criteria has been size (larger than 3cm or 5cm diameter according to different authors). Is there anyone with information about which of the two is a superior predictor of failed needle aspiration?
Sharpe  and colleagues used the National Cancer Data Base to study the effect of bilateral mastectomy for early-stage breast cancer on length of hospital stay, readmission rate, 30-day mortality, and time to adjuvant therapy.
The authors begin by acknowledging the recent increase in bilateral mastectomies for patients diagnosed with early-stage breast cancer, a trend that is entirely driven by patients rather than experts. They also point out that surgeons typically address reasons for and possible benefits of different procedures and often leave out the possible (unintended) harm caused by such procedures or options. In this case, it is important for clinicians to figure out whether a delay in the initiation of chemotherapy could result in harm.
Longer wait times may be related to the practice of obtaining additional preoperative imaging with MRI, or consultations with plastic surgery or genetic specialists for second opinions. National guidelines from the National Comprehensive Cancer Network and the National Quality Forum recommend adjuvant chemotherapy to be administered within 120 days of diagnosis of breast cancer.
What is your opinion?
1. Sharpe SM et al. Impact of Bilateral Versus Unilateral Mastectomy on Short Term Outcomes and Adjuvant Therapy, 2003-2010: A Report from the National Cancer Data Base. Ann Surg Oncol. 2014 Apr 12.
I am working in breast cancer research, comparing Luminal A, Luminal B to TNBC cell lines. I see that some of the Luminals share characteristics of TNBC. I wonder if we should compare all Luminals to TNBC or should we stratify luminals?
The introduction of SLNB has reduced the incidence of lymphedema in patients with node negative axillae but in patients with locally advanced breast cancer patients, ALND is still the standard of care. ARM has shown potential to identify the arm lymph nodes and lymphatics but is it really feasible in patients with LABC?
There are five main methods in breast volume measurement. Although there is no standard method for breast volumetry, volumetry with Grossman-Roudner Disk seems to have some advantages like easiness, simplicity, comfort for the patient and cost.
I like to know about the statistical figures and the sites of recurrence/secondary cancer development after surgical removal of tumor in breast. How its managed if this occurs?
I am going to assess the patients discomfort while performing ROLL and compare it to wire guided localisation.
I'm reading on the medical reviews for TNBC and I'm a little bit confused with these terms.